The Army has recently been testing
automated drug dispensing systems. The Army believes the following scenario
will be possible in the not-too-distant future.

A sick soldier about to be deployed
on a mission needs antibiotics. He is stationed in a remote site, and the
after-hours clinic he visited was unable to fill his prescription. All
the pharmacies in town are closed. The soldier pulls up to an automated
teller-like machine on post and enters an access code. The prescription
is electronically dispensed by a pharmacist and entered on the soldierís
medical record. The soldier simply inserts an identification card and the
antibiotics are automatically dispensed. A button on the machine initiates
contact with a pharmacist to answer any questions the patient has about
drug interactions or side effects. See ĎATMí Telepharmacy at http://www.mmt-kmi.com/Archives/3_6_art2.htm.At the request of the Texas State Board
of Pharmacy, the Attorney General for Texas recently considered whether
state law permits the use of an automated dispensing machine to dispense
prescription drugs at a nursing home. See Opinion No. JC-0186 dated February
24, 2000.

At issue was an automated dispensing
system machine designed to mechanically sort and then individually label
and package oral medications for administration to patients in nursing
homes. A licensed pharmacist would load the machine with bulk medications.
A nurse would input a prescription order into a nursing home computer.
An off-site pharmacist would review the prescription order together with
the patientís medication record, and send an order to the automated dispensing
system at the nursing home instructing the machine to prepare and dispense
the prescription. Access to the bulk medications contained in the automated
dispensing system (other than those dispensed) would be limited to a licensed
pharmacist. Such a system could potentially reduce medical error, save
time and money, and allow physicians to easily vary dosage and duration
of prescriptions based on a patientís response. Automated dispensing systems
are already used in some hospitals that hold a valid pharmacy license.
However, nursing homes typically do not hold pharmacy licenses, nor do
they have a licensed pharmacist on staff.

The Texas Pharmacy Act (Tex. Occ. Code
Ann. § 551.003) defines a "pharmacy" as "a facility at which a prescription
drug or medication order is received, processed, or dispensedÖ" Under the
Act, "dispense" means "to prepare, package, compound, or label, in the
course of professional practice, a prescription drug or device for delivery
to an ultimate user or the userís agent under a practitionerís lawful order."
"Deliver" or "delivery" means "the actual, constructive, or attempted transfer
of a prescription drug or device or controlled substance from one person
to anotherÖ" "Labeling" is defined as "the process of affixing a label
. . . to a drug or device container . . ." The Act defines "pharmacist"
as "a person licensed by the Board to practice pharmacy." Finally, the
"practice of pharmacy" includes, among other things, "being responsible
for: (i) dispensing a prescription drug order or distributing a medication
order; [and] (ii) compounding or labeling a drug or device."

Since the machine would label, package,
and dispense prescription medications, the Attorney General concluded that
the machine is legally a "pharmacy" and thus requires a pharmacy license.
Further, a pharmacy license entails having a pharmacist on the premises
when the pharmacy is open.

The White
Paper on Automation in Pharmacy is an effort by the Automation
in Pharmacy Initiative, a coalition of pharmacy associations, members of
state boards of pharmacy, and representatives from the pharmacy automation
industry. The White Paper addresses technical and regulatory issues associated
with automation. The paper concludes that regulatory barriers in many states
limit use of automated dispensing machines, and proposes adoption by states
of amendments to the National Association of Boards of Pharmacy Model State
Pharmacy Act and Model Rules to allow broader use of automatic dispensing
machines. See http://www.ascp.com/public/pubs/tcp/1998/mar/appendix1.shtml.